영구치 보존을 고려한 함치성 낭종의 외과적 처치
Surgical Management of Dentigerous Cyst for Preserving Permanent Tooth Buds
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함치성 낭종은 미맹출치의 치관을 둘러싸는 퇴축법랑상피로부터 기원한다. 대부분의 함치성 낭은 적출술 또는 조대술로치료된다. 조대술을 통해 낭 내부의 압력이 감소하고 골의 재생이 일어나면서 낭벽은 정상적인 점막으로 변하게 된다. 조대술은 적출술에 비해 인접 주요 구조물을 보호할 수 있다는 장점이 있다. 본 증례는 5세와 11세 남아의 상악 정중 과잉치와 치수 치료된 하악 유구치 부위에서 발견된 각각의 함치성 낭종을 치료한증례로 모두 낭의 크기가 2개 이상의 인접 영구치의 변위를 발생시킬 정도로 크기가 매우 컸다. 환자의 나이가 어리고 낭의크기가 커서 조대술을 이용하여 치료하였고 그 결과 변위된 인접 영구치의 맹출 방향이 개선되고 방사선투과상의 크기가 점점 감소하는 것으로 관찰되었다. 본 증례와 같이 크기가 매우 큰 함치성 낭의 경우에서 조대술을 이용하여 치료할 경우 위치가 변이된 인접치아를 보존하고영구치의 자연 맹출을 유도할 수 있는 양호한 결과가 예상되기에 보고하는 바이다.
Abstract
Dentigerous cyst is the most common developmental odontogenic cyst of the jaw which is associated withunerupted teeth. Treatment modalities range from enucleation to marsupialization. Enucleation is the process inwhich the cyst is completely removed, and this is usually indicated for smaller lesions. Larger cysts can be treatedby marsupialization, which is a process that consists of making a surgical cavity on the wall of the cyst, emptyingits content and maintaining the continuity between the cyst and the oral cavity. This procedure allowsdecompression of the cyst, regeneration of the bone-defected area, and also lets the wall of the cyst change intonormal mucosa. This technique will protect adjacent structures and will promote spontaneous eruption ofsuccedaneous teeth previously surrounded by the cyst. These are two case reports of a 5-year-old and an 11-year-old boy with dentigerous cysts found regardingsupernumerary tooth and pulpotomized mandibular primary molars, respectively. Due to the large size of thecysts, both cases were treated with marsupialization. This case report shows that in cases regarding large-sized dentigerous cysts, marsupialization can be aneffective surgical technique that promotes spontaneous eruption of cyst-involved succedaneous teeth and thepreservation of adjacent teeth.
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